Give birth at home and you can wave goodbye to $3000

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Home birth blues ... Lisa Metcalfe at home in Austinmer yesterday with her 12-week-old son, Robert. Giving birth at home was wonderful but, as it turned out, an expensive experience. Photo: Dean Sewell

When Robert Denham entered the world it was "beautiful, really gentle ... a wonderful celebration", says his mother, Lisa Metcalfe.

Attended by a midwife, Meredith Jones, who had cared for Ms Metcalfe throughout her third pregnancy, the birth took place at the family's Austinmer home. With no hospital bed fees, no surgery and no anaesthetist, Robert's arrival on Mother's Day could hardly have been simpler and, it would seem, cheaper.

But despite having private health insurance, his parents had to bear the full cost of Ms Jones's $3000 fee - which covered pregnancy, birth and postnatal care - because private midwifery does not attract a Medicare rebate and is covered by few private health funds.

If the family had chosen to engage an obstetrician for Robert's birth they would not have been out of pocket at all. But the total cost to their insurer, Medicare and the public hospital system would have been much higher - and statistics show the mother would have been more likely to have had a caesarean or other intervention.

"It would be saving the health system money. I don't think it's very just. [Rebate structures] promote the more expensive option - private obstetrics - as the only option."

Sally Tracy, an associate professor in midwifery at the University of Technology, Sydney, said taxpayers were spending a disproportionate and growing amount on private obstetricians, compared with midwives, whose services are not subsidised unless they work in public hospitals.

"The Government is subsidising [obstetricians'] indemnity. There's a subsidy for private health insurance and a Medicare rebate which are all coming out of taxpayers' money," she said. "What is all that costing? They just have no idea. There's this lack of accountability across the board."

Justine Caines, the national president of Maternity Coalition, a birth advocacy group, called on the Coalition and Labor to consider the funding of midwife-led care and solving the impasse over professional indemnity cover for midwives.

Insurance, which is a condition of midwives' professional registration, has not been available in Australia since 2001, and some states have begun deregistering midwives. Ms Caines also said Medicare should offer rebates for midwifery.